Sizing Up Medical Availability Orlando Still Offers The Most Services, But Others Are Catching Up

July 1, 1985|By Peter Adams of The Sentinel Staff

Orlando's first hospital got its start in a hotel that went bust in 1892. The seven cottages at the edge of town were too far off the main thoroughfares to make a good resort, so they were converted into a hospital and sanitarium. In those days, patients paid $12 a week for a bed equipped with mosquito netting, there was one operating room with wooden floors and two cottages were set aside for contagious diseases. The successor to that hospital is the 855- bed Orlando Regional Medical Center.

Almost a century later and with the addition of 7,000 hospital beds, Central Florida patients need insurance plans to pay the hundreds of dollars a week for a stay in a hospital that may provide open-heart surgery, cancer treatment, or a machine that pulverizes kidney stones with a blast of sound waves.

While Central Florida hospitals do offer a varied medical menu, Miami's Bascom Palmer Eye Institute still is regarded as the state's best hospital for eye surgery, and Shands Teaching Hospital in Gainesville is regarded as the best for treating severe burns.

Orlando hospitals remain the most sophisticated providers of medical service in the six-county Central Florida region, each offering a specialty they believe will set them apart, bring in the paying patients and attract physicians from the top medical schools, which adds to the institution's prestige, said Lester Abberger, deputy director of the Florida Hospital Cost Containment Board.

''Availability (of medical care) here is as good as anywhere in the Southeast,'' Abberger said. He explained that hospitals make a commitment to a particular medical specialty based on need in the community, profitability and the demands of the medical staff.

Consider the not-for-profit Orlando Regional Medical Center and Adventist church-owned Florida Hospital, which have taken separate roads to becoming Central Florida's two largest hospitals.

By the spring of 1988, Orlando Regional Medical Center is expected to open its Arnold Palmer Children's Hospital and Perinatal Center, a children's hospital with 220 beds and a 20-room labor and delivery suite.

The hospital will be one of three freestanding facilities in the country that puts the medical care of mother and child under one roof.

The cost of the hospital is $10 million, but obstetrics is a high-cash-flow side of the medical profession and the center is expected to be profitable, said Dr. Vincent Giusti, chairman of ORMC's pediatric division.

Florida Hospital started to develop its specialty in heart surgery in the mid-1960s after one of its physicians invented a procedure that shortened the time it takes to insert a heart pacemaker.

Since then, Florida Hospital has invested more than $25 million in its cardiac care, said Fred Lee, a Florida Hospital vice president.

Continually expanding the hospital's market share of heart surgeries is the best way to protect that investment, Lee said.

''Our first long-range plan is to make sure that we are a key referring hospital with wide regional reach for heart surgery. It's a third of our business here,'' Lee said. Last year the hospital performed 1,760 open-heart surgeries, three times as many as all of Orlando's other hospitals combined, ranking it eighth in the country.

Once a hospital has the equipment and the surgical team in place to perform open-heart surgery, there are opportunities to perform other sophisticated procedures of the vital organs, including kidney transplants.

A fourth of all kidney transplants in the state are performed at the 1,175-bed Florida Hospital.

Before a hospital can buy expensive equipment or add specialized facilities it has to pass a state review -- called a certificate of need request -- to avoid duplication of services.

The certificate of need must explain how the hospital will pay for the additional service or facility, who will utilize it and whether it will meet construction standards.

A review takes about five months and a hospital's request is expected to meet the community's needs as spelled out in a yearly health plan, said Steven Windham, executive director of the Local Health Council of East Central Florida.

For example, Florida Hospital and Orlando Regional Medical Center each have been approved this year for magnetic resonance imagers, which use magnetic and radio frequencies to make detailed photographs of internal organs. The machines cost more than $2 million each.

Generally, more certificate-of-need requests are denied than approved ''and it will get tighter,'' Windham said. That's because there has been an 8 percent decrease in the utilization of hospitals between 1983 and 1984 in Orange, Osceola, Seminole and Brevard counties, the area under the local council's jurisdiction.

He explained the shift from expensive in-hospital stays to more out- patient services is responsible. The four-county area now has a surplus of 460 beds, Windham said.